AEGiS-14IAC: Association between prevalence and incidence of Herpes Simplex Virus-2 (HSV-2), syphilis and HIV-1 infection in rural Uganda.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Association between prevalence and incidence of Herpes Simplex Virus-2 (HSV-2), syphilis and HIV-1 infection in rural Uganda.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. MoOrC1011)

Kamali A, Muhangi L, Quigley M, Whitworth J
Medical Research Council, Entebbe, Uganda

BACKGROUND: To determine the association between prevalence and incidence of Herpes Simplex virus-2 (HSV-2), syphilis and HIV infection in a community-randomized trial (CRT).

METHODS: About 20000 adults (13+ years) residing in 18 communities were enrolled in a CRT between 1994-2000 targeting improved sexually transmitted infections (STI) management and behavioural change to reduce HIV transmission. Three serological surveys were conducted in a subset of the population every 18 months. Sera were tested for HIV using 2 enzyme immunoassays (EIAs), for active syphilis using Treponema pallidum haemagglutination assay (TPHA) and Rapid Plasma Reagin (RPR), and for HSV-2 (13-29 years) using monoclonal blocking EIA.

RESULTS: Prevalence at baseline was 9.6% for HIV, 27.7% for HSV-2 and 13.0% for active syphilis (TPHA+/RPR+). The incidence rates per 100 person-years (events/person-years) were 0.74 (304/41060) for HIV, 3.1 (428/13607) for HSV-2, and 2.6 (961/36676) for active syphilis. Both HSV-2 prevalence and active syphilis prevalence were higher among HIV positive than HIV negative adults (80% versus 23% for HSV-2, p<0.001; 19% versus 12% for active syphilis, p<0.001). Similarly, HSV-2 and active syphilis prevalence were associated with HIV incidence, age/sex adjusted rate ratios were 6.17 [95% CI: 4.46-8.55] and 1.42 [95% CI: 1.00-2.04] respectively. HSV-2 incidence per 100 person-years was significantly higher among HIV positives (15.7) than HIV negatives (3.0), p<0.001. However, active syphilis incidence per 100 person-years was similar in HIV positives (2.7) and HIV negatives (2.6), p=0.72.

CONCLUSION: We have observed a strong association between HIV infection and HSV-2 infection. There is a need to consider anti-HSV-2 therapy in STI syndromic management in order to reduce HIV transmission.

Keywords: AEGIS, Prevalence, Incidence, Herpesvirus 2, Human, HIV Infections, Syphilis, HIV, HIV Seroprevalence, HIV Seropositivity, Uganda, Treponema pallidum, Adult, epidemiology

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